Alternatives to statins for reducing bad cholesterol

Q: I’ve tried a couple of statins, and the side effects — particularly muscle pain — always knock me off them. The problem is my cholesterol is almost 400, and I'm scared I’ll have a heart attack before I’m 45, like my dad did. What do you suggest I do? — Frank S., Pittsburgh

A: Start by getting the genetic test for familial high cholesterol, also called familial hypercholesterolemia (FH); it affects about 1 in 500 folks. It happens because a genetic mutation makes your body unable to clear lousy LDL cholesterol from your bloodstream.

In adults it’s diagnosed when there’s a family history of premature heart disease and lousy LDL cholesterol is 190mg/dL or higher (in kids it’s 160 and up). Genetic testing is recommended to confirm a diagnosis of FH if there’s some doubt about the cause of elevated LDL. Without effective treatment, guys with FH have a 50 percent chance of having a heart attack before age 50; gals with FH have a 30 percent chance.

Statins normally would be your first line of defense, and for many people they’re life-savers, but for you, their side effects are a deal breaker. There are other cholesterol- lowering medications, such as niacin and ezetimibe (used singly they lower LDL 19 percent to 32 percent) that you might tolerate, but neither seems to substantially decrease heart attack risk.

If you do have FH, there’s a treatment called apheresis, in which blood plasma, removed from your body, is passed through filters to remove extra LDL-cholesterol, and then returned to your body; this is a very difficult treatment regimen.

But here’s better news: Researchers have discovered a once-a-month injection of a monoclonal antibody called evolocumab helps your body get rid of LDL cholesterol. LDL levels fall by about 60 percent — without taking a statin or another anticholesterol medication. (For folks with very high LDL that is NOT familial, this antibody reduces levels by up to 75 percent.) Although it won’t hit the market for a few years, you might log onto www.clinicaltrials. gov to see if there are trials for this drug in which you want to enroll. For now, work with your doc on a new treatment plan that improves your meds, nutrition, increases physical activity safely and reduces stress.

Q: I read your article in April about how e-cigarettes don’t really help you kick the cigarette habit and may be risky, but you didn’t mention anything about secondhand vapors. Is there any danger there? — George G., Pullman, Washington

A: It’s starting to look like there are potentially dangerous emissions from e-cigarettes. They pollute the air less than conventional cigarettes, but one big problem is that most (not all) e-cigarettes are made in China, and that raises quality control concerns.

For example, the Food and Drug Administration tested several cartridges and found that lead, nickel and copper — which are listed on the FDA’s “harmful and potentially harmful chemicals” list — were released into the air when e-cigs were used. And when the World Health Organization tested secondhand emissions, they found low levels of formaldehyde, acetaldehyde, isoprene, acetic acid, 2-butanodione, acetone, propanol, propylene glycol and nicotine.

We agree with the American Heart Association that an evidence-based regulatory scheme should be in place and e-cigarettes should be prohibited wherever tobacco is banned. The products also should have marketing restrictions identical to tobacco restrictions.

So far, Minnesota taxes e-cigarettes as a tobacco product, and 27 states restrict sales to minors. More than 100 municipalities prohibit the use of e-cigarettes in smoke-free indoor environments. Worldwide, Brazil, Singapore, Canada, the Seychelles and Uruguay have prohibited the sale of e-cigarettes.

If anyone you know thinks that it’s safe to drag on an e-cigarette around infants or children, ask them not to do that. And as for adults who want to quit smoking, use patches and support groups to get you off nicotine, and then stay inhale-exhale-free for your sake and the sake of those around you.